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Stroke and pulmonary thromboembolism after a long flight
Author(s) -
Belvís R.,
Masjuan J.,
GarcíaBarragán N.,
Cocho D.,
MartíFàbregas J.,
Santamaría A.,
Leta R. G.,
MartínezCastrillo J. C.,
FernándezRuiz L. C.,
Gilo F.,
MartíVilalta J. L.
Publication year - 2005
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2005.01070.x
Subject(s) - medicine , patent foramen ovale , stroke (engine) , cardiology , paradoxical embolism , transcranial doppler , pulmonary embolism , venous thrombosis , thrombosis , migraine , mechanical engineering , engineering
In the economy class syndrome (ECS) the patient presents a deep venous thrombosis (DVT) with or without pulmonary thromboembolism (PTE) during or after a long trip as a result of prolonged immobilization. Economy class stroke syndrome is an infrequent ECS variant in which ischemic stroke is associated with a patent foramen ovale (PFO). Few cases have been published in the literature to date. We present a patient who suffered a PTE and an ischemic stroke immediately after a transoceanic flight. A 36‐year‐old woman with no significant medical or familial history flew economy class from Lima, Peru, to Madrid, Spain. On disembarkation she presented sudden dyspnea and a depressed level of consciousness, global aphasia, and right hemiparesis. A pulmonary scintigraphy showed a PTE and a cranial MRI revealed an ischemic infarct in the left middle cerebral artery territory. We simultaneously performed a transesophageal echocardiography and a transcranial Doppler and observed a massive right‐to‐left shunt through a PFO. The patient was a heterozygous carrier of the C46T mutation of coagulation factor XII. The appearance of a stroke following a long trip is suggestive of paradoxical embolism through a PFO, mainly if it is associated with a DVT and/or a PTE. The cause of the initial event, the DVT, could be a prothrombotic state.